Received date: November 11, 2016; Accepted date: December 19, 2016; Published date: December 26, 2016
Citation: Ajayi AB, Ajayi VD, Oyetunji I, et al. Online Fertility Survey. Med Clin Rev. 2016, 2:33. doi: 10.21767/2471-299X.1000042
Copyright: © 2016 Ajayi AB, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Objective: To determine the level of knowledge on common fertility issues among the population studied.
Outcome measures: Fifty percent or more of the respondents correctly answering a particular question was adjudged as sufficient knowledge of that particular fertility issue and less than 50% adjudged insufficient knowledge.
Methodology: The study was conducted by the Nordica Fertility Centre Lagos in 2012. A simple multiple choice questionnaire with 20 questions about fertility was posted on the Nordica Fertility Centre Lagos website for visitors to the site to answer. Results were collated and analyzed using SPSS 17.0.
Results: A total of 289 persons participated in the online survey. Majority of the respondents lived in the Lagos area but responses came in from virtually all over Nigeria. A few responses came from outside Nigeria. There was sufficient knowledge on such issues as definition of infertility, age at which woman's fertility is maximal, frequency of intercourse per week when trying to conceive, who to see after a year of tests with no success, basic infertility tests for men, normal sperm counts, most common sperm abnormality, strongest risk factor for infertility in women, how long to wait before seeking help in women less than 35 years of age, what is unexplained infertility, meaning of menopause and what was the most successful option for older women trying to conceive. There was insufficient knowledge on sex positions increasing the likelihood of conception, monthly chance of conception, gender that experiences infertility most, causes of infertility, fertile period and irregular cycles. Up to 65% of the respondents felt certain sex positions increase the likelihood of conception. Over 30% said that a woman's fertility begins to decline from 40 years and beyond. About forty seven percent felt mere change of dates of menses monthly meant cycles were irregular. Only 49.5% correctly knew the fertile period. About 61% thought monthly natural fertility/conception rates was 50-70%. Staphylococcus was considered the leading factor in the causation of infertility by 41% of respondents, scored higher than male, female and combined factors. Majority of the respondents, 42.9% felt women were the gender that experienced infertility most while 11.4% of them said it was the men.
Conclusion: There is still a need to improve knowledge on fertility and infertility. The online portal is a good source for this.
Fertility; Knowledge; Internet; Infertility
Infertility is of public health importance in Nigeria and many developing nations because of its high prevalence and especially due to its serious social implications . It is a major source of distress and frustration for men and women and medical practitioners. It causes great worry and sorrow for many couples in Africa especially for the women . The knowledge of infertility and fertility determines, to a large extent, the health seeking behavior of sufferers. There seems to be a lot of ignorance and miss information and superstitious beliefs and myths out there about fertility, infertility, its causes and how to best manage it. A lot of the difficulties in infertility management arise from delay in presentation. Some of this delay is due to lack of knowledge. The fertility IQ 2012 healthcare provider survey revealed that most patients were aware of general fertility information but were less aware of specific details . When men and women become aware of all the issues surrounding fertility and infertility they would be more likely able to properly address this problem. One major way of reaching people these days of the computer age especially the young generation who are the main target audience in fertility information dissemination is via the internet.
The study used the Nordica Lagos website www.nordicalagos.org as the location for the study. A simple 20 question multiple choice self-administered questionnaires were posted on the website in May 2012 for visitors to the site to answer and submit.
The study was conducted over a period of one month. The questionnaire had time duration for it to be answered once logged into the site and the questionnaire clicked and once submitted could not be edited. At the end of the study the responses were scored and the results collated and analysed using SPSS version 17.0. If at least 50% of respondents correctly answered a question it was adjudged as sufficient knowledge on that item or issue and vice versa.
A total of 289 persons participated in the online survey. Majority of the respondents lived in the Lagos area but responses came in from virtually all over Nigeria. A few responses came from outside Nigeria.
Population perception of fertility characteristics of a woman is illustrated in Table 1; which 54.7% and 44.3% respondents respectively believed that age at which a woman’s fertility is maximal falls between 20 and 24 years and that fertility begins to wane at 35 years. The Table also shows there was insufficient knowledge on monthly chance of conception as majority (181, 62.6%) of the respondents said 2 months was “time for a 20-year old to get pregnant having regular unprotected intercourse.” The Table also shows that there was insufficient knowledge on what fertile period is as a many of the respondents (143, 49.5%) regarded this to be 4 days before ovulation until day of ovulation.
|Age (years) at which woman's fertility is maximal||15-19||58||20.1|
|Age (years) at which woman’s fertility begins to decline||30||72||24.9|
|Time for a 20-year old to get pregnant having regular unprotected intercourse||5 months||33||11.4|
|What is the fertile period||The day of ovulation||74||25.6|
|4 days before ovulation until day of ovulation||143||49.5|
|3 days after ovulation||42||14.5|
|One week after ovulation||30||10.4|
Table 1: Percentage distribution of public perception of woman’s fertility characteristics.
Public perception of irregular cycle was inappropriate as most (135, 46.7%) respondents felt mere change of dates of menses monthly meant cycles were irregular (Table 2). However, it was observed that the public was quite knowledgeable on the definition of infertility (233, 80.6%), frequency of intercourse per week when trying to conceive (187, 64.7%), strongest risk factor for infertility in women (152, 52.6%) and definition of unexplained infertility (260, 90.0%). It was surprising that a high proportion (120, 41.5%) of public considered staphylococcus as cause of infertility over male (2, 0.7%), female (4, 1.4%) or combined (35, 12.1%) factor. Although gender that experiences infertility most was inappropriately assumed by the public as female (124, 42.9%), unexplained infertility (260, 90.0%) and strongest risk factors for infertility in women (152, 52.6%) were correctly identified as “cause of infertility is not known” and as “advancing age.”
|What is irregular cycle||Change of dates each month||135||46.7|
|Absence of menstrual period for 2-3 months or more||131||45.3|
|Shorter days of menstrual flow||19||6.6|
|Total absence of menstrual flow||4||1.4|
|What is infertility||Inability to conceive after 1 month of sexual intercourse without contraception||22||7.6|
|Inability to get pregnant after marriage||21||7.3|
|Inability to conceive after one year of sexual intercourse without contraception||233||80.6|
|Inability to get pregnant within 3 months of sexual intercourse||13||4.5|
|Frequency of intercourse per week when trying to conceive||2-3 times per week||187||64.7|
|Once a week||1||0.3|
|Only in the fertile period||64||22.1|
|Causes of infertility||Male factor||2||0.7|
|Gender that mostly experiences infertility||Male||33||11.4|
|Neither (Don’t know)||29||10|
|Strongest risk factor for infertility in women||Advancing age||152||52.6|
|Previous venereal disease||74||25.6|
|What is unexplained infertility||Father of child is unknown||7||2.4|
|Cause of infertility is not known||260||90|
|Patient won’t let us touch her||7||2.4|
|Abstinence induced infertility||15||5.2|
Table 2: Public views on cycle irregularity, infertility and conception.
Distribution of perceptions of the characteristics concerning older women is as described in Table 3. Public opinion was correct on the meaning of menopause, believed by a high proportion (213, 73.7%) of respondents as decline in ovarian function. Most successful option for conception among older women was correctly perceived as IVF using donor eggs by most respondents (163, 56.4%) while few (24, 8.3%) considered it to be Gamete intra-fallopian transfer.
|What does menopause mean||Declining ovarian function||213||73.7|
|Proper functioning of the ovaries||6||2.1|
|Eggs in the ovaries are depleted||68||23.5|
|Most successful option for older women||IVF using own eggs||70||24.2|
|IVF using donor eggs||163||56.4|
|Gamete intrafallopian transfer||24||8.3|
Table 3: Distribution of characteristics of older women.
Where male characteristics in fertility issue was concerned, approximately half (144, 49.8%) of the public took normal sperm count as >20 million/ml though higher proportions (246, 85.1%; 226, 78.2%) saw low sperm count and Seminal Fluid Analysis respectively as the most common sperm abnormality and the basic infertility test done for men in the environment of survey (Table 4).
|Normal sperm count||1-5 million/ml||34||11.8|
|Most common sperm abnormality||Poor sperm motility||37||12.8|
|Low sperm count||246||85.1|
|Basic infertility test done for men||Serum FSH||19||6.6|
|Seminal Fluid Analysis||226||78.2|
|Post coital test||2||0.7|
Table 4: Characteristics of males in fertility and infertility.
Surprisingly a high proportion (189, 65.4%) of the respondents mistakenly believed that certain positions increase the likelihood of conception indicating insufficient knowledge on this issue (Table 5). Nevertheless, there was sufficient knowledge on who to see after a year of tests with no success as a sizeable proportion (174, 60.2%) opted for Fertility Specialist while most (157, 54.3%) decided that a woman aged <35 years should wait for 12 months before seeking fertility assistance.
|Certain sex positions increase the likelihood of conception||True||189||65.4|
|None of the above||9||3.1|
|How long to wait before seeking help by women <35 years||6 months||106||36.7|
|After a year of trying and tests without success who should a woman/man see||General Practitioner||4||1.4|
Table 5: Sex position, time trying to conceive and help-seeking attitude.
There is still a need to improve knowledge on fertility and infertility. The online portal is a good source for this. The knowledge from such surveys as this could be used by health care providers to tailor the information they provide to optimize their communication with patients .
This study consists of some limitations related to the cross sectional nature of the study, it looks for associations, not causes and effects. The DHS is a household based survey, and hence excludes significant non-household population groups, like those living on the street or in institutions, for example, prisons, colleges or boarding schools, military barracks, refugee camps, which could have more risk sexual behaviors than the household population. Similarly, as the questionnaire is designed to collect self-reported responses, there could be recall biases and socially-desirable responses and the missing data in the data files may affect the results.
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